Conception

5 things to know about menopause and fertility

There is an increasing number of women who give birth to their first child over the age of 35. Before the beginning of the twenty-first century, the most prolific group was between 25 and 29 years of age. Currently the range in which most pregnancies are contained is between 30 and 34 years with a clear increase in pregnancies towards the age of 40 .

The fuss raised by #FertilityDay has left, in addition to the controversy, considerations that should not be underestimated. We are not here to evaluate the economic and/or social reasons that drive women to postpone motherhood. We have probably experienced many on our skin.

What we would like to underline is that if the decision to have a child is postponed by choice or construction, one must in any case be aware that there is a natural process of female aging which concerns reproductive capacity . Women between 45 and 55 undergo menopause, an event which occurs on average around the age of 50 but which is preceded by a few years of symptoms (pre-menopause) in which fertility is reduced to a minimum.

Age-related infertility is not a problem that only starts with menopause

Women are already born with around 1-2 million egg cells. Their quantity decreases by hundreds every month (a 37-year-old woman has about 25,000), until there are only a few dozen left near menopause.

The decrease in the number and quality of these eggs, as well as age-related uterine changes, contribute to the decrease in fertility. This occurs not only before menopause but even before the signs of pre-menopause become apparent.

As menopause approaches, the chance of conceiving a child naturally decreases significantly

Women under the age of 35 have a maximum 25% chance of becoming pregnant during sexual intercourse on their fertile days. Beyond this age, a woman’s reproductive potential decreases, and after 40 the chances of pregnancy with targeted intercourse are less than 10% each month.

Although pregnancy is theoretically possible until menopause is confirmed by 12 consecutive months without menstrual periods,  age is often the most important factor to consider when trying to conceive.

Once a woman has entered menopause, it is no longer possible to get pregnant naturally: the only way this is possible is through egg donation and in vitro fertilization.

Early menopause

Most women experience menopause between 45-45 years of age.

However, one in 100 women suffers premature menopause or premature ovarian failure, which occurs before the age of 40. It can happen without the woman noticing the symptoms, perhaps she becomes aware of them when she decides to have some checks because she does not get pregnant despite months of trying.

The symptoms of early menopause are very similar to those of natural menopause: irregular or missed menstrual cycles, more abundant or less menstrual flows, hot flashes, etc.

A precise medical cause of premature menopause has not yet been identified, there is evidence of recurrence in families, therefore a hereditary component is assumed. Lifestyle (smoking and obesity) as well as autoimmune diseases can also increase the incidence.

There are diagnostic tests to be carried out on the couple to understand why a child does not arrive. Among these is the verification of the woman’s ovarian reserve which is carried out through hormonal dosages on the third day of menstruation and an ultrasound. During the ultrasound, the number of follicles is counted to check if the woman has a good level of oocytes (immature egg cells). This allows doctors to understand if the problem of difficulty conceiving is related to aging.

In these cases, the timing of the diagnosis is essential in order not to waste time.

Is it possible to undergo fertility treatments once you have entered menopause?

If the couple chooses or is forced by force majeure to look for a child “late”, it is right to know that the possibility of conceiving decreases as the woman gets older.

In these cases, the freezing of the oocytes is recommended but not beyond the age of 38. This age limit ensures that the egg cells are more likely to thaw without problems. These eggs can also be used by the woman herself even after entering menopause.

If a woman has not chosen to freeze her eggs, the only effective method of getting pregnant when she is in peri-menopause is egg donation. Currently, egg donation is the most effective treatment available for women who are in peri-menopause and wish to become mothers. With egg donation, the egg cell of a donor is fertilized in vitro with the partner’s sperm and then the embryo obtained is implanted in the uterus.

Obviously if the woman wants to become pregnant once she has already entered menopause, she will have to undergo hormonal treatments to prepare the uterus to receive an embryo.

5. The age limit for a fertility treatment

Regardless of the ethical or legal aspect, in general, 50 years is the reasonable upper limit for recommending fertility treatment.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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